HIV/AIDS Skepticism

Pointing to evidence that HIV is not the necessary and sufficient cause of AIDS

HIV/AIDS SCAM: Have antiretroviral drugs saved 3 million life-years?

Posted by Henry Bauer on 2008/07/06

In the previous post [Antiretroviral therapy has SAVED 3 MILLION life-years, 1 July 2008], I showed that the impression conveyed by “millions” is misleading. The claim actually amounts to an estimate that HAART has saved, at an annual cost of about $20 billion, only about 13% of AIDS victims, in other words about 1 in 8, which is hardly what’s implied by the commonly used description of HAART as “lifesaving”.

I referred also in that earlier post to “dishonesty” in the Walensky et al. article. That charge reflects the fact that only a by-the-way sentence on the fourth page of the article modifies drastically the claim, made in the Abstract, of “at least 3.0 million” life-years saved: “Of these, 1,184,851 years have already been realized, and 1,629,041 years are being accrued by current patients”. The claimed 3 million turns out to be less than 1.2 million! Yet that is once again fudged or masked by the last sentence of the article: “Ten years after the introduction of potent combination ART, at least 3 million years of life have been saved in the United States” [emphasis added]. Counting projected future savings as already in hand might not survive an independent audit.

Repeating the calculations in the earlier post with the lower figure of 1.2 million of actually realized savings, we find that there were saved by 2003 not 13% of patients but only 6%, at expenditure of more than $180,000 per saved life-year, or $12.5 million per life; and our productivity in GDP terms then represents a measly return of 0.36% on this human capital. Such are the numbers that Fauci apparently believes to justify current expenditure on HIV/AIDS. One can be sure, moreover, that the computer model was designed and the calculations made with a view to presenting as rosy a picture as possible. If this is the best they can come up with, then it’s time to stop talking about HIV/AIDS as a manageable, chronic but not fatal disease.

Not only is the claimed benefit of treatment much less than impressive, the claim actually lacks any solid foundation whatsoever. It relies on a computer model that makes a number of unjustifiable assumptions, and it ignores such central issues as the acknowledged toxicity of the antiretroviral treatment as well as how the definition of AIDS has changed, and thereby the health-state of people being treated.

Here is the essence of the Walensky article: “The Cost-Effectiveness of Preventing AIDS Complications (CEPAC) model was used to estimate per-person survival benefits. CEPAC is a widely published computer-based state-transition simulation model of HIV disease that incorporates CD4 cell count; HIV RNA level; ART efficacy; OI incidence, treatment, and prophylaxis; and other important clinical information [16–18, 21]. “State transition” means that the model characterizes the progression of disease in an individual patient as a sequence of transitions from one ‘health state’ to another. . . . In the model, the level of HIV RNA determines the rate of CD4 cell count decline, and the absolute CD4 cell count governs the monthly risk of OIs and death”.
One hardly needs to read any further, given that Rodriguez et al. (JAMA 296 [2006], 1498-1506) found a lack of correlation between “HIV RNA level”—otherwise known as viral load—and the rate of CD4 decline. This fact alone would be enough to vitiate the model; but there are also no valid studies of ART efficacy using untreated controls. As to prophylaxis of opportunistic infections, more is said below.

Walensky et al. considered “6 distinct eras of HIV/AIDS treatment from 1989 to 2003”. But about 50,000 AIDS deaths had already been reported up to 1989 (CDC 1990), about 35,000 of those during the AZT monotherapy years of 1987 and 1988. Some (or most or perhaps even all) of those deaths were caused or hastened by the AZT, and those lost life-years should surely be subtracted from the savings calculated from 1989 on, since HAART typically incorporates AZT or an analog of it, albeit at much lower doses than in the monotherapy era. Instead, Walensky et al. apparently seek to hide AZT toxicity by saying that “we excluded the early benefits of antiretroviral mono- and dual-drug therapy when survival benefits were more limited”, a fine illustration of double-speak: “more limited benefits” here stands for “no benefit, just caused harm”.

The first era commences with “prophylaxis for Pneumocystis jiroveci pneumonia (PCP) starting in 1989”, ignoring that Michael Callen and Josef Sonnabend had pioneered prophylaxis against PCP in AIDS victims years earlier. Callen cites data from the Centers for Disease Control and Prevention that more than 30,000 people had died of PCP by February 1989 even though the possibility of prophylaxis had been known since 1977. Callen himself had urged Fauci in May 1987 to recommend prophylaxis, but Fauci refused; nearly 17,000 PCP deaths occurred between May 1987 and February 1989 (pp. 30-31 in Michael Callen, Surviving AIDS, HarperCollins 1990). That is in direct contradiction to the claim that “88% of eligible patients in the pre-ART era were receiving OI [opportunistic infection, includes PCP] prophylaxis” (Walensky et al., p.12). How many of those 30,000 or 17,000 PCP deaths should be subtracted from Walensky’s 3 million — or actually 1.2 million — saved years of life? 30,000 lives lost to PCP, after all, already represent more than 2 million life-years, and even 17,000 lives amount to over a million-and-a-quarter life-years, either of which would wipe out entirely all the life-years claimed to have been saved between 1989 and 2003.

Walensky et al. cite an estimate that only 57% of known “HIV-positive” people are receiving treatment, and they assert that additional life-year-savings would result if more were being treated. But how many of the non-treated are avoiding antiretroviral drugs by choice? Certainly among gay men, knowledge of the fearsome “side”-effects of antiretroviral drugs has been widespread for two decades. Moreover, any reader of the official Treatment Guidelines learns that “In the era of combination antiretroviral therapy, several large observational studies have indicated that the risk of several non-AIDS-defining conditions, including cardiovascular diseases, liver-related events, renal disease, and certain non-AIDS malignancies . . . is greater than the risk for AIDS”. How then could Walensky et al. legitimately ignore these toxicities, as they do: “The analysis did not account for later ART-related toxicities that may result in, for example, cardiac disease or diabetes”. They wave aside the iatrogenic harm from ART even further by opining that “hyperlipidemia reduces overall life expectancy by ~1 month”. When your doctor tells you that your cholesterol is too high and that you should begin a lifelong course of expensive statin drugs — whose deleterious “side” effects also call for regular doses of Coenzyme Q10, which few doctors will tell you, however —, try responding that you have it on good authority that the potential benefit of conquering hyperlipidemia is only about 1 month of extra life. Let me know what your doctor says to that.

————————-

Noted by Walensky et al. is that “after 1992, ~70% of new AIDS diagnoses were made according to a CD4 cell count criterion of <200 cells/mm3 alone”. This criterion for an AIDS diagnosis is unique to the United States, and patients thus diagnosed may display no symptoms of illness. Thus up to 70% of “AIDS” patients receiving antiretroviral drugs in the United States since 1993 have been clinically healthy when they begin “treatment”. It would then be hardly surprising that survival rates increased from the years before 1993 when this CD4-count criterion was introduced, for initially healthy people will surely survive toxic drugs longer than people who are already ill: “projected per-person survival after an AIDS diagnosis increased from 19 months (1.6 years) in the absence of treatment to 179 months (14.9 years) by 2003, a gain of 160 months (13.3 years)” [emphasis added]. The all-knowing computer model can apparently be sure already in 2003 that patients will survive on average into 2018. But even this projection hardly justifies the assertion that AIDS is now “a highly treatable chronic condition”, given that even by 2004 — 8 years into the “lifesaving” HAART era — most deaths from “HIV disease” were still occurring among people around 40 years of age, just as two decades earlier [Table 42, p. 236, in “National Center for Health Statistics: Health, United States, 2007 with Chartbook on Trends in the Health of Americans”, Hyattsville, MD, 2007; see “HIV DISEASE” IS NOT AN ILLNESS, 19 March 2008].

Puzzling is the statement that “Mean per-child survival gains for the averted infections ranged from 60.5 years if the child was born before 1996 (before combination ART) to 45.8 years during 1996-1999, when combination ART was available”. If ART is better, why is the survival gain from it only ¾ of the earlier survival gain from pre-ART prophylaxis of opportunistic infections?

——————-

It also remains for me a continuing mystery that so many AIDS researchers, reviewers of HIV/AIDS manuscripts, and editors of journals that publish this material are so lacking in elementary numeracy as to pepper their articles with numbers like “832,179 years in ART 3”, “2,813,892” years saved, and so on. Numbers no less than words should convey meaning. The only thing conveyed clearly by “2,813,892” is that the writers take computer outputs as sacrosanct and don’t think about what the numbers mean. Those extra digits are not only meaningless, they positively distract the reader, making necessary a mental rounding-off to recognize that the substantive claim is “about 2.8 million”; not many people, after all, are used to digesting 7-digit numbers and savoring their significance. In the Walensky et al. article, the mystery of this abusive mathematical incompetence is only deepened by the fact that the authors’ affiliations include departments of epidemiology and biostatistics.

——————-

Walensky et al. “employed a model-based approach, conducting repeated analyses to explore the clinical consequences of alternative patient-care-innovation pathways”. The whole article deals not with actual patients but with “hypothetical patients”. This fulfills the suggestion, reported in a previous post, that one no longer needs human beings for clinical studies, computers can conveniently substitute [VIRTUAL HIV/AIDS RESEARCH AND TREATMENT, 17 June 2008]. The most convenient thing about this, of course, is that it’s much easier to get the results you want from a computer model you have yourself designed than from observations of real people.

Here’s the point to bear in mind whenever the gurus parade the outputs of their computer models:
A computer model can be guaranteed to mimic reality faithfully only if everything about that reality is already known in every detail. But if that is so, then one doesn’t need a computer model. Computer models are experiments carried out on surrogates of reality, surrogates that are unavoidably simplified and based on assumptions about reality. In the Walensky et al. case, the model incorporates assumptions about what happens to a person with a given viral load and CD4 count under no treatment, and what happens to individuals with given viral loads and CD4 counts under a variety of treatment regimens: all of which are based on guesses, because clinical trials with proper controls have never been carried out to determine properly the parameters needed for such a model. Moreover, as earlier mentioned, the article by Rodriguez et al. found no correlation between “viral load” and subsequent decline in CD4 counts. Further, the article ignores the well established phenomenon of “long-term non-progressors” or “elite controllers”, individuals who demonstrate that being “HIV-positive” does not necessarily lead to destruction of the immune system, illness, and death. How could the fates of non-treated “patients” be modeled when this phenomenon is ignored? When it is not even known what proportion of people are potentially elite controllers?

The outputs of this model deserve no credence whatsoever. The claim of more than 3 million saved life-years is utterly bogus. Even were it not bogus, it would reveal the claimed benefits of antiretroviral therapy to be at best marginal and procured at egregiously excessive cost.

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4 Responses to “HIV/AIDS SCAM: Have antiretroviral drugs saved 3 million life-years?”

  1. Martin said

    Hi Dr. Bauer, Great post. I assume that the continuing “mystery” of why peer reviewers looking askance at the published data (garbage) and passing it on is rhetorical. These people want to keep their jobs. To ask the wrong questions would get them fired. They have to apply for grants from the same place: the NIH. As long as you don’t question what Dr. Mengele (Fauci) wants, you get your grant, the press is granted access, the “researchers” keep their jobs, the drug companies keep making their drugs and pay the physicians to push their products.

  2. MacDonald said

    Actually, computer models not only simplify reality, they simplify our assumptions about reality. But one really has to wonder why those assumptions have to be so simple in the first place?

    The introduction to the Walensky study defines HIV/AIDS care as consisting of three components:

    “opportunistic-infection prophylaxis, treatment with ART, and the prevention of mother-to-
    child transmission (pMTCT) of HIV”

    In other words, the three components of HIV/AIDS care are:

    1. The Drugs

    2. The Drugs

    3. The Drugs

    Even if we accept the basic assumptions of the authors, why do we have to operate with a 25-year flat learning-curve with regard to,

    1) Human-to-human care and counseling in “HIV disease” management?

    2) Nutritional science and “HIV disease” management?

    3) Exercise and general health considerations (smoking, drinking, etc.) in “HIV disease” management?

    It cannot be because these things are too hard to quantify. There are a number of studies describing and quantifying the benefits of these factors.

    Still, they are not credited with a single saved year out of the three million allotted to ART and its other drug complements.

  3. MacDonald said

    WHO SAID 3 MILLION YEARS? WE’RE TALKING LIVES, BABY!

    If you thought 3 million saved life-years was a bit hyperbolic, it’s only because you’re not a mover and a shaker like the righteousness-exuding president of AHF:

    “WASHINGTON, Jul 16, 2008 (BUSINESS WIRE) — AIDS Healthcare Foundation (AHF) ( http://www.aidshealth.org), which provides AIDS care and treatment services to more than 79,000 individuals in 20 countries worldwide, applauded the U.S. Senate for passing the legislation (vote: 80/16) re-authorizing PEPFAR (the President’s Emergency Plan for AIDS Relief), the successful US global AIDS program. AHF lauded the Senate for prioritizing lifesaving treatment through its restoration of a provision in the current law that more than half of the funding be spent on treatment. The agreement will also make it possible for as many as five million people worldwide to access antiretroviral treatment over the next five years via PEPFAR-backed programs. Currently, less than two million people are receiving treatment through PEPFAR.
    “It is no exaggeration to say that millions of additional lives of people living with HIV/AIDS around the world will now be saved thanks to the actions of Congress today and we thank those courageous legislators and staffers who supported AHF’s efforts and worked so hard to make this happen,” said Michael Weinstein, President, AIDS Healthcare Foundation.”

    Doesn’t that just make you feel good in that special place deep inside?

    http://www.marketwatch.com/news/story/ahf-treatment-proposal-accepted-us/story.aspx?guid=%7B08E5DFC7-FDDB-4463-AC93-5D313B3492FF%7D&dist=hppr

  4. MacDonald said

    WHO SAID 3 MILLION LIVES SAVED? TRY 7 MILLION!

    “WASHINGTON, Jul 30, 2008 (BUSINESS WIRE) — AIDS Healthcare Foundation (AHF), hailed President Bush for signing legislation to re-authorize PEPFAR (the President’s Emergency Plan for AIDS Relief). The measure, which was signed in a formal signing ceremony earlier today in Washington, increases funding for the successful global AIDS program from $15 billion up to $48 billion over the next five years. As a result, PEPFAR, which is likely to be among the President’s most successful and lasting legacies, will save five to seven million lives over the next five years”.

    http://www.marketwatch.com/news/story/bush-signs-historic-global-aids/story.aspx?guid=%7B41280A3D-0822-4231-8B57-C700F0F8436B%7D&dist=hppr

    Please don’t forget to take a look at the neat little graph they have linked, showing how real and tangible the estimates are.

    Even more remarkable is the fact that 7 million is the entire estimated HIV+ population in the USA seven times over. But in the U.S., the lavish spending, independent of PEPFAR, has hardly made a dent. To the contrary:

    “Black American AIDS Report Says Epidemic Growing in US
    By Joe DeCapua
    Washington
    29 July 2008″

    http://voanews.com/english/Africa/2008-07-29-voa65.cfm

    But when you’re in the AIDS business, you can have your cake, eat it, give it away and keep the rest in the freezer. You can have an epidemic that peaked a decade ago…

    “LONDON – Fewer people are dying of AIDS, more patients are on HIV medication and the global AIDS epidemic is stable after peaking in the late 1990s.”

    http://www.journalgazette.net/apps/pbcs.dll/article?AID=/20080730/NEWS10/807300368/0/NEWS

    … yet won’t peak for another 40 years:

    “Could this devastation by AIDS in Africa be only the beginning? The National Intelligence Council (NIC) report of October 2002 predicted that the epidemic will move east, striking India, Russia, China, and Southeast Asia, and that if current trends continue, 70 million more will worldwide die from AIDS over the next 20 years. Even so, once HIV is set loose in Asia, home to the majority of the world’s population, it may not peak for 40 years, killing hundreds of millions.”

    http://www.larouchepub.com/other/2003/3004aids_cens.html

    You can continuously make claims about how the virus is outpacing our best prevention and treatment efforts worldwide…

    “The report, issued ahead of the 17th International AIDS Conference, opening in Mexico City on Sunday, said there were 33 million people living with HIV last year, compared with 32.7 million in 2006″.

    http://www.theaustralian.news.com.au/story/0,25197,24101247-12377,00.html

    … but still claim that the increase in the PEPFAR budget alone will cut worldwide AIDS mortality by almost half in a few years.

    AIDS mortality 2007 was estimated around 2 million, according to the Australian article. 2 million X 5 years = 10 million. PEPPFAR alone is going to save 7 million in five years by tripling the spending. If the additional lives saved are proportional to the additional spending, it would come out at 4.5 million in 5 years – almost one million lives a year.

    To appreciate how optimistic this estimate is, compare with the same article’s claim that overall (not only PEPFAR) prevention and treatment efforts has decreased annual worldwide AIDS mortality by 200,000 between 2005-2007. The PEPFAR increase alone, it is claimed, will quintuple that number.

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